“Fetishism” and Humanitarian Aid – an Interview

Peter Rohloff has training in parasitology, internal medicine and pediatrics. He practices in Boston, MA at Brigham and Women's Hospital and Boston Children's Hospital. Since 2003, Peter has been working in Guatemala, where he serves as the medical director for a health systems NGO – Wuqu’ Kawoq | Maya Health Alliance. Peter’s interests include the management of chronic diseases of children and adults in resource poor settings and how indigeneity, cultural, and language barriers impact access to and utilization of health care.
@wuqukawoq

I recently ran across a fascinating article in the Third World Quarterly, The fetishism of humanitarian objects and the management of malnutrition in emergencies. The article is by researcher Tom Scott Smith of Oxford, who is preparing a book manuscript on the “objects” of humanitarian aid. I was so intrigued by his article that I called him up, and this is the conversation that resulted. He has a lot of important and provocative things to say about humanitarianism, malnutrition, Plumpynut, and reinventing the wheel. Enjoy!

Tell me a bit about your background.

Well, I worked in development management for about six to seven years before returning to academic study. During this time I was always very interested in humanitarianism because it seemed to me – as a development practitioner – to be morally uncomplicated. When people have a really basic need there seems to be a strong moral argument to provide material assistance as efficiently as possible – to get them food, shelter, water and so on straight away – and there seems to be an ethical simplicity about all of this, especially from the perspective of development, with all its uncomfortable imperialistic overtones of ‘developing’ other people

Of course, humanitarianism is not like that at all. Its complexity becomes obvious when you look at ‘humanitarian paradoxes’ – those situations when good intentions leads to terrible consequences. The best example is probably the Great Lakes crisis in the mid-1990s when perpetrators of genocide were manipulating aid to rebuild their strength. Such situations got me really fascinated about humanitarianism, its history, and its unintended political consequences. The more I read, the more I realized that humanitarianism is incredibly political, right down to its details. I also realized how little had been written about the history of relief at the micro-level – regarding the politics of objects – and I became convinced that even the technical practices of relief had political implications.

You recently published an article in the Third World Quarterly about the “fetishism” of humanitarian objects.

Yes, that article emerged from fieldwork during 2012, when I was looking at the practical aspects of nutrition programs. This research took me to Jordan and South Sudan, where I noticed that the nutritional system relied a great deal on imported, technological objects.

The article starts from a situation in South Sudan, where I saw aid workers wedded to a very standardized, inflexible approach to relief, which was centred around two objects in particular – Plumpy’nut and the MUAC band. Plumpy’nut is really the best example, as it is often described it as some kind of wonder food, a miracle cure for malnutrition. It struck me as deeply misguided that you could have such a simplistic technical fix for something so deeply political as malnutrition, so I looked at how the aid workers themselves fetishized these things, how they ignored their histories, how the exaggerated their importance, and how this led to a very structured and inflexible approach to their work.

Can you describe in a bit more detail the case of Plumpynut and what you observed in the field?

Well Plumpynut is a sachet of fortified peanut butter that is distributed in therapeutic feeding programs. It doesn’t need to be cooked, or prepared, it has a very long shelf life, it is packed with calories, and it can just be given to children directly, who rip it open and eat the contents. I really don’t want to detract from the profound achievement of this object, since there is a lot of evidence that it does an enormous amount of good. It has been credited with transforming the relationship of aid agencies to their beneficiaries, moving therapeutic care into something less top-down, and more led by local people. Therapeutic feeding methods used to involve admitting children to a clinic for several weeks and giving them a milk-based formula, but this was so disempowering because mothers had to stay with the child, they were not allowed to prepare the formula themselves because of contamination, and so they were not entrusted to look after their own child. Plumpynut allows feeding to be shifted back to people’s homes. People take these sachets with them and consume them in their own time, on their own terms.

The issue I want to raise about Plumpy’nut is the way it has become so dominant in emergencies. The older approach was flawed, but Plumpy’nut is not the miracle it is made out to be. Yes, Plumpy’nut may place some control back into people’s hands, but only in a limited way, because it is presented as a medicine. It is associated with a set of rules and it needs to be eaten in a particular way, at a particular time.

For some people this is its great strength, but I think the object reflects a lack of trust amongst nutritionists of people in disasters. It fits into a much wider trend in humanitarian intervention over the last 50 years to reduce food to nutrients, and then find ways to direct these nutrients into people’s bodies with minimal involvement from people themselves. In this article I want to remind people – in an intentionally provocative way – that we don’t eat nutrients, we eat food. This whole nutrient-centric approach to aid takes control away from beneficiaries and places it in the hands of humanitarians. To talk of nutrients is to speak a language alien to many people around the world. Plumpynut may have decentralized therapeutic feeding in some ways, but there remains an element of top-down control and it is basically peanut butter in a fancy packet, which has been unnecessarily mystified. Most importantly, it is a limited technical fix that does not address any of the political facets of malnutrition nor allow people to be truly involved in identifying or addressing their hunger.

Is this about generating neoliberal subjects, about disciplining beneficiaries by technocratic aid?

Lots of people have made that argument, but I’ve resisted it. I don’t think there’s any direct evidential connection between the delivery of Plumpynut in a refugee camp and some kind of neoliberal empire. What I do want to do, however, is draw out the way in which this particular type of solution allows us to stop thinking about the structural conditions that keep people poor and hungry. By focusing on the technical fix, we do not have to think about why people need the fix in the first place. Plumpy’nut doesn’t solve malnutrition, all it does is build an individual’s body back up to weight – like all food, but faster.

Another example of a fetishized humanitarian object is Sprinkles. Again, this has been received extremely favorably in the media, presented as though it will transform responses to malnutrition. But one of the characteristics of fetishised humanitarian objects is that they are perceived as recent discoveries, when in fact they have long pasts and are rooted in quite contingent political visions. What I find so interesting about Sprinkles is how it emerges from 1950s, 1960s modernism, when humanitarians were looking to science for solutions to malnutrition. The irony in this history is that Sprinkles and its antecedents represent a real poverty of vision, as if the way to solve deep long-term malnutrition is to sprinkle some sort of magical fairy dust on the horrible gruels that people have to eat. I mean, this ignores the real problem and focuses on a short-term fix. It is such a restrictive vision, which came from an era of such modernist hope. Something similar can be said of Plumpynut, which is very tasty, but it doesn’t cure entrenched structural and political problems.

This perspective of 50-60 years of technical nutrition solutions is very interesting and important. In your article you mention that Plumpynut seems to be portrayed as springing forth de novo, without context, without reference to any of these previous trials and products. How does that happen?

It is hard to say exactly how it happens, but I think a lot of it has to do with the lack of institutional memory in aid agencies. I was at a conference recently, and a very senior humanitarian worker in one of the big agencies talked about humanitarianism as a young industry. As a historian, I was astounded because humanitarianism is far from young – it goes back to the middle of the 19th century, at the very least. Even in its modern, institutionalized form, it is older than Coca Cola, Oxo, or pretty much any of those commodities that seem to have been around for so long. Yet humanitarians seem to think that their work is new. They have a real lack of historical awareness.

This is partly due to the nature of the work, which does not really allow for much reflection, or for keeping and perusing archives. The drive to prove success, the need to demonstrate that you have achieved results – all this attention on the funding cycle prevents looking back to the past, and it prevents being critical. There is also a big turnover of staff: humanitarianism is something many people do in their twenties before settling down and having children, which means new blood is always coming in and people are constantly reinventing the wheel. Often aid workers are not aware of what people in their own organization did 10 years ago.

In this context, fetishizing objects serves a purpose. It makes life easy. If you are convinced that there is a miracle solution to malnutrition, or if you believe that the power of science and technology has yielded these objects then you don’t have to look so hard for more long term solutions. You can also ignore how similar so-called miracle cures have been tried in the past, and how they have generally failed.

I make similar case with the MUAC [mid upper arm circumference] band. Again, I’m being deliberately provocative here, but I wonder if it is necessary to use the band to diagnose malnutrition. If you talk to people and listen, they know exactly who are the members of their community who need help. But the MUAC band objectifies hunger, streamlining the process. The band allows aid workers to externalize a very difficult choice, about who to give food and who not to give food. This is a horrible, debilitating decision, and the MUAC band externalizes this process onto an object, introducing some regularity for the aid worker. But does it help the people who are suffering? Is it really necessary to identify who is starving to death – people who are perfectly obvious? The MUAC band doesn’t allow people to articulate their experiences, it seems to presume people need a strip of measuring tape to work out who is starving to death, and it produces a very “production line” approach to humanitarian aid.

What do these sorts of reflections and insights mean for rank and file aid works. How can we combat the institutional amnesia and the magical thinking?

First of all, I don’t want to detract from the achievements of these individual objects. And I certainly don’t want to suggest there is not a place for something like Plumpynut. There are obviously situations where there is no other option, and people need this kind of fix. But often this template is applied in many more situations that is strictly necessary. If there was to be a lesson from my work it would be a call for thinking more creatively, for involving local people in the process, for trying to consider structural causes and long-term processes. Of course raising these concerns is by no means an original contribution to the field, but they are so often forgotten because of the scale of suffering and because institutional architecture is designed to deliver short term solutions. I think we all need a reminder.

And let’s not forget the way nutritional projects tie into the global food economy. Again, this is not an original point, but within famine there are very often foods available regionally which are not located or drawn upon. This is what the humanitarian food pipeline often misses. One thing that struck me in South Sudan, was that at least in the rainy season, the land was very fertile, there was so much land around the refugee camp, but no one was distributing seeds to grow crops. And most of the refugees I interviewed said: this is what we want… seeds to grow crops, tools to work the land, the ability to occupy ourselves and grow the foods we are used to eating. But in the supplementary program they were giving out imported Corn-Soy Blend, which no-one really wanted to eat. For me, all of this is symptomatic of a system that doesn’t trust refugees and that doesn’t involve them.

Often these longer term approaches are often not adopted because of an idea of emergency. When you call something an emergency, you suggest that there is no time to involve local people. No time to give out seeds and crops. There are some genuine emergencies, of course, but thankfully, such situations are relatively rare. Most of the time humanitarians are burdened with a standardised template, which is applied to vastly different environments, often when people are far from helpless. We need to resist labeling these situations as ‘emergencies’, and if we really want to help people we should stop declaring their situation as exceptional, but instead sit down, take time, and look for more creative ways to help them secure the foods and futures they desire. The declaration of an ‘emergency’ can be an excuse not to think more creatively. There is the assumption that people aren’t able to solve their own problems.

And this technocracy denies agency and subjectivity. It is “suppressing the subjective experience of hunger.”

Yes, you have all of these people shuffling in line, being silently measured by the MUAC band, and being admitted a preset assistance program that relies on objects none of them are familiar with or used to eating – like Plumpy’nut, Sprinkles, or Corn-Soy Blend. Hunger becomes something that only experts can sort out. This is what I want to critique: the idea that hunger and food are complex and that they need special treatment. The idea that hunger is best understood as a biochemical process that occurs deep inside the body, which we need a nutritionist to understand, or the idea that we need magical technological foods in disaster. Most of the time we do not. People are perfectly capable of working out when they need food, and working out what they need to eat.